Pathology of tumors associated with pathogenic germline variants in 9 breast cancer susceptibility genes

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IMPORTANCE Rare germline genetic variants in several genes are associated with increased breast cancer (BC) risk, but their precise contributions to different disease subtypes are unclear. This information is relevant to guidelines for gene panel testing and risk prediction. OBJECTIVE To characterize tumors associated with BC susceptibility genes in large-scale population- or hospital-based studies. DESIGN, SETTING, AND PARTICIPANTS The multicenter, international case-control analysis of the BRIDGES study included 42 680 patients and 46 387 control participants, comprising women aged 18 to 79 years who were sampled independently of family history from 38 studies. Studies were conducted between 1991 and 2016. Sequencing and analysis took place between 2016 and 2021. EXPOSURES Protein-truncating variants and likely pathogenic missense variants in ATM, BARD1, BRCA1, BRCA2, CHEK2, PALB2, RAD51C, RAD51D, and TP53. MAIN OUTCOMES AND MEASURES The intrinsic-like BC subtypes as defined by estrogen receptor, progesterone receptor, and ERBB2 (formerly known as HER2) status, and tumor grade; morphology; size; stage; lymph node involvement; subtype-specific odds ratios (ORs) for carrying protein-truncating variants and pathogenic missense variants in the 9 BC susceptibility genes. RESULTS The mean (SD) ages at interview (control participants) and diagnosis (cases) were 55.1 (11.9) and 55.8 (10.6) years, respectively; all participants were of European or East Asian ethnicity. There was substantial heterogeneity in the distribution of intrinsic subtypes by gene. RAD51C, RAD51D, and BARD1 variants were associated mainly with triple-negative disease (OR, 6.19 [95% CI, 3.17-12.12]; OR, 6.19 [95% CI, 2.99-12.79]; and OR, 10.05 [95% CI, 5.27-19.19], respectively). CHEK2 variants were associated with all subtypes (with ORs ranging from 2.21-3.17) except for triple-negative disease. For ATM variants, the association was strongest for the hormone receptor (HR)+ERBB2 high-grade subtype (OR, 4.99; 95% CI, 3.68-6.76). BRCA1 was associated with increased risk of all subtypes, but the ORs varied widely, being highest for triple-negative disease (OR, 55.32; 95% CI, 40.51-75.55). BRCA2 and PALB2 variants were also associated with triple-negative disease. TP53 variants were most strongly associated with HR+ERBB2+ and HR-ERBB2+ subtypes. Tumors occurring in pathogenic variant carriers were of higher grade. For most genes and subtypes, a decline in ORs was observed with increasing age. Together, the 9 genes were associated with 27.3% of all triple-negative tumors in women 40 years or younger. CONCLUSIONS AND RELEVANCE The results of this case-control study suggest that variants in the 9 BC risk genes differ substantially in their associated pathology but are generally associated with triple-negative and/or high-grade disease. Knowing the age and tumor subtype distributions associated with individual BC genes can potentially aid guidelines for gene panel testing, risk prediction, and variant classification and guide targeted screening strategies.

OriginalsprogEngelsk
Artikelnummere216744
TidsskriftJAMA Oncology
Vol/bind8
Udgave nummer3
Antal sider11
ISSN2374-2437
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
reported grants from the University of Cambridge, European Union Horizon 2020, Wellcome Trust, Genome Canada, Canadian Institutes of Health Research, and National Cancer Institute during the conduct of the study. Dr Allen reported grants from EU Horizons 2020 during the conduct of the study. Dr Bolla reported grants from Cancer Research UK and the National Institutes of Health (NIH) during the conduct of the study. Dr Andrulis reported grants from NIH during the conduct of the study. Dr Briceno reported grants from Universidad de la Sabana during the conduct of the study. Dr Fasching reported personal fees from Roche, Lilly, Novartis, Pierre Fabre, Gilead, Seagen, Eisai, Daiichi Sankyo, AstraZeneca, Merck Sharp & Dohme, and Pfizer and grants from Cepheid and BioNtech during the conduct of the study. Dr Giles reported grants from National Health and Medical Research Council during the conduct of the study. Dr Hahnen reported personal fees from AstraZeneca outside the submitted work. Dr Hartikainen reported grants from Cancer Foundation Finland during the conduct of the study. Ms Morra reported being paid by an EU grant during the conduct of the study. Dr Park-Simon reported being a recipient of the Claudia von Schilling Stiftung Award during the conduct of the study. Dr Schmutzler reported grants from German Cancer Aid during the conduct of the study. Dr Southey reported grants from National Health and Medical Research Council (NHMRC) (Australia) during the conduct of the study. Dr Spurdle reported grants from the NHMRC during the conduct of the study. Dr Pharoah reported grants from Cancer Research UK during the conduct of the study. Dr Kvist reported grants from European Union Horizon 2020 research and innovation program BRIDGES during the conduct of the study. Dr Nevanlinna reported grants from Helsinki University Hospital, Sigrid Juselius Foundation, and Cancer Foundation Finland during the conduct of the study as well as honorarium from AstraZeneca outside the submitted work. Dr Camp reported grants from the University of Utah, Huntsman Cancer Foundation, and the National Cancer Institute. Dr Schmidt reported grants from EU during the conduct of the study. Dr Easton reported grants from the European Commission and Wellcome Trust outside the submitted work. No other disclosures were reported.

Funding Information:
was supported by the European Union Horizon 2020 research and innovation program BRIDGES (grant 634935) and the Wellcome Trust (v203477/ Z/16/Z). The Breast Cancer Association Consortium (BCAC) is funded by the European Union's Horizon 2020 Research and Innovation Programme (grants 634935 and 633784 for BRIDGES and B-CAST, respectively) and the PERSPECTIVE I&I project, which is funded by the Government of Canada through Genome Canada and the Canadian Institutes of Health Research, the Ministère de l’Économie et de l'Innovation du Québec, through Genome Québec, the Quebec Breast Cancer Foundation. Additional funding for BCAC is provided via the Confluence project, which is funded with intramural funds from the National Cancer Institute Intramural Research Program. The ABCS study was supported by the Dutch Cancer Society (grants NKI 2007-3839; 2009 4363). The ACP study is funded by the Breast Cancer Research Trust, UK. Prof Muir and Dr Lophatananon are supported by the National Institute of Health Research (NIHR) Manchester Biomedical Research Centre, the Allan Turing Institute under the Engineering and Physical Sciences Research Council grant EP/N510129/1. The work of the BBCC was partly funded by ELAN-Fond of the University Hospital of Erlangen. For BIGGS, Dr Saloustros is supported by the NIHR Comprehensive Biomedical Research Centre, Guy's & St. Thomas' National Health Service (NHS) Foundation Trust in partnership with King's College London. Dr Tomlinson is supported by the Oxford Biomedical Research Centre. The BREast Oncology GAlician Network (BREOGAN) is funded by Acción Estratégica de Salud del Instituto de Salud Carlos III FIS grant PI12/02125/Cofinanciado FEDER; Acción Estratégica de Salud del Instituto de Salud Carlos III FIS Intrasalud (grant PI13/01136), and grant PI17/ 00918/Cofinanciado FEDER. Funding was received from Xerencia de Xestion Integrada de Vigo-SERGAS, Instituto de Salud Carlos III grant 10CSA012E and Consellería de Industria Programa Sectorial de Investigación Aplicada grant EC11-192. The BSUCH study was supported by the Dietmar-Hopp Foundation, the Helmholtz Society, and the German Cancer Research Center. The CCGP is supported by funding from the University of Crete. The CECILE study was supported by Fondation de France, Institut National du Cancer, Ligue Nationale contre le Cancer, Agence Nationale de Sécurité Sanitaire, de l'Alimentation, de l'Environnement et du Travail, and Agence Nationale de la Recherche. The CGPS was supported by the Chief Physician Johan Boserup and Lise Boserup Fund, the Danish Medical Research Council, and Herlev and Gentofte Hospital. The CNIO-BCS was supported by the Instituto de Salud Carlos III, the Red Temática de Investigación Cooperativa en Cáncer, and grants from the Asociación Española Contra el Cáncer and the Fondo de Investigación Sanitario (PI11/00923 and PI12/00070). Dr Osorio is partially supported by FIS PI19/00640 supported by FEDER funds and the Spanish Network on Rare Diseases (CIBERER). COLBCCC is supported by the German Cancer Research Center. Dr Torres was in part supported by a postdoctoral fellowship from the Alexander von Humboldt Foundation. PROCAS is funded from NIHR grant PGfAR 0707-10031. Prof Evans and Dr Howell are supported by the NIHR Manchester Biomedical Research Centre (IS-BRC-1215-20007). The German Consortium of Hereditary Breast and Ovarian Cancer is supported by the German Cancer Aid (grants 110837 and 70114178) and Federal Ministry of Education and Research, Germany (grant 01GY1901). This work was also funded by the European Regional Development Fund and Free State of Saxony, Germany (Leipzig Research Centre for Civilization Diseases project numbers 713-241202, 713-241202, 14505/2470, 14575/ 2470). The GENICA was funded by the Federal Ministry of Education and Research Germany grants 01KW9975/5, 01KW9976/8, 01KW9977/0, and 01KW0114, the Robert Bosch Foundation, Deutsches Krebsforschungszentrum (DKFZ), the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, and the Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany. Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates (CZD/16/ 6) and the Scottish Funding Council (HR03006) and is currently supported by the Wellcome Trust (216767/Z/19/Z). Genotyping of the GS:SFHS samples was carried out by the Genetics Core Laboratory at the Edinburgh Clinical Research Facility, University of Edinburgh, Scotland and was funded by the Medical Research Council UK and the Wellcome Trust (104036/Z/14/Z). Funding for identification of cases and contribution to BCAC funded in part by the Wellcome Trust Seed Award. The GESBC was supported by the Deutsche Krebshilfe e. V. and the German Cancer Research Center. The HABCS study was supported by the Claudia von Schilling Foundation for Breast Cancer Research, Lower Saxonian Cancer Society, German Research Foundation (grant Do761/10-1), and the Rudolf Bartling Foundation. The HEBCS was financially supported by the Helsinki University Hospital Research Fund, the Finnish Cancer Society, and the Sigrid Juselius Foundation. The HMBCS was supported by a grant from the German Research Foundation (Do761/10-1) and the Rudolf Bartling Foundation. The HUBCS was supported by a grant from the German Federal Ministry of Research and Education (RUS08/017). Drs Bermisheva and Khusnutdinova were supported by the megagrant from the Government of Russian Federation (No. 075-15-2021-595) and Saint Petersburg State University (grant 602368366). Financial support for KARBAC was provided through the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Swedish Cancer Society, Gustav V Jubilee foundation, and Bert von Kantzows foundation. The KARMA study was supported by Märit and Hans Rausings Initiative Against Breast Cancer. The KBCP was financially supported by the government funding of Kuopio University Hospital, Cancer Fund of North Savo, the Finnish Cancer Organizations, and by the strategic funding of the University of Eastern Finland. The kConFab is supported by a grant from the National Breast Cancer Foundation and previously by the National Health and Medical Research Council (NHMRC), Queensland Cancer Fund, Cancer Councils of New South Wales, Victoria, Tasmania, and South Australia, and the Cancer Foundation of Western Australia. Financial support for the AOCS was provided by the US Army Medical Research and Materiel Command (DAMD17-01-1-0729), Cancer Council Victoria, Queensland Cancer Fund, Cancer Council New South Wales, Cancer Council, South Australia, Cancer Foundation of Western Australia, Cancer Council, Tasmania, and the National Health and Medical Research Council of Australia (NHMRC 400413, 400281, and 199600). Dr Chenevix-Trench is supported by the NHMRC. The MARIE study was supported by the Deutsche Krebshilfe e.V. (70-2892-BR I, 106332, 108253,

Funding Information:
108419, 110826, and 110828), Hamburg Cancer Society, German Cancer Research Center, and the Federal Ministry of Education and Research Germany (01KH0402). The MASTOS study was supported by Cyprus Research Promotion Foundation grants 0104/13 and 0104/17 and the Cyprus Institute of Neurology and Genetics. The Melbourne Collaborative Cohort Study (MCCS) cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further augmented by Australian National Health and Medical Research Council grants 209057, 396414, and 1074383 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database. The MBCSG is supported by funds from the Italian Association for Cancer Research to Drs Radice and Peterlongo. The MYBRCA is funded by research grants from the Wellcome Trust grant (v203477/Z/16/Z) and the Malaysian Ministry of Higher Education (UM.C/HlR/ MOHE/06) and Cancer Research Malaysia. The NBCS has received funding from the K.G. Jebsen Centre for Breast Cancer Research, the Research Council of Norway grant 193387/V50 (to Drs Børresen-Dale and Kristensen) and grant 193387/H10 (to Drs Børresen-Dale and Kristensen), South Eastern Norway Health Authority (grant 39346 to Dr Børresen-Dale), and the Norwegian Cancer Society (to Drs Børresen-Dale and Kristensen). The Ontario Familial Breast Cancer Registry (OFBCR) was supported by grant U01CA164920 from the US National Cancer Institute of the National Institutes of Health. The PBCS was funded by Intramural Research Funds of the National Cancer Institute. Genotyping for PLCO was supported by the Intramural Research Program of the National Institutes of HealthThe SASBAC study was supported by funding from the Agency for Science, Technology and Research of Singapore, the National Institutes of Health, and the Susan G. Komen Breast Cancer Foundation. SEARCH is funded by Cancer Research UK (grants C490/ A10124 and C490/A16561) and supported by the NIHR Biomedical Research Centre at the University of Cambridge. The University of Cambridge has received salary support for Prof Pharoah from the NHS in the East of England through the Clinical Academic Reserve. SGBCC is funded by the National Research Foundation Singapore, NUS start-up Grant, National University Cancer Institute Singapore Centre Grant, Breast Cancer Prevention Programme, Asian Breast Cancer Research Fund and the NMRC Clinician Scientist Award. Population-based controls were from the Multi-Ethnic Cohort funded by grants from the Ministry of Health, Singapore, National University of Singapore and National University Health System. SKKDKFZS is supported by the German Cancer Research Center. The SZBCS was supported by grant PBZ_KBN_122/P05/2004 and the program of the Minister of Science and Higher Education under the name “Regional Initiative of Excellence” in 2019-022 project number 002/RID/2018/19. UBCS was supported by funding from National Cancer Institute grant R01 CA163353 (Dr Camp) and the Women’s Cancer Center at the Huntsman Cancer Institute. Data collection for UBCS was supported by the Utah Population Database and Utah Cancer Registry. Dr Spurdle was supported by an NHMRC Investigator Fellowship (APP177524).

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